More than three billion people live with the threat of malaria throughout the world, which results in a significant impact on economic global economic productivity. While significant progress against malaria has been observed in the past 5 years, strategies to quantify this progress are elusive because of the limitations of malaria diagnosis. The elimination of malaria in challenging endemic settings will require new approaches to understand the sustained transmission of Plasmodium. Efforts to eradicate malaria have been stymied because of an inability to screen populations efficiently and at an affordable cost in malarious regions which arguably contributes to a poorly directed parasite control effort and malaria resurgence.
Present methods for malaria diagnosis by microscopy take approximately 1 hour and are often confounded by the availability of expert microscopists, low parasitemia, and mixed Plasmodium species infections. The low sensitivity of light microscopy has been an issue for some time. Significant levels of error have been shown in the microscopic diagnosis of malaria with false positive rates and false negatives as high as 50. Antigen-based RDTs have made significant contributions to malaria epidemiological and clinical studies. Although the tests are relatively easy to perform and can provide a diagnostic result in 15-20 minutes in the setting where blood samples are collected (rural villages and health outposts to clinical laboratories), they are quite costly. The RDTs, however, do not reliably detect parasites at low parasitemia (<200 parasitized cells/μL), they are less sensitive in detecting P. vivax, and their detection of P. malariae and P. ovale is uncertain. Additionally, as with conventional microscopy, the utility of RDTs would only be useful in malaria elimination efforts during pre-elimination time periods.